Standards for public agencies

2020 Edition

Behavior Support and Management (PA-BSM) 2: Behavior Support and Management Practices

Behavior support and management practices promote respect, healing, and positive behavior and prevent the need for restrictive behavior management interventions.
2020 Edition

Currently viewing: BEHAVIOR SUPPORT AND MANAGEMENT (PA-BSM)

VIEW THE STANDARDS

Purpose

The agency’s behavior support and management policies and practices promote positive behavior and protect the safety of service recipients and staff.
Note: Please see the Case Record Checklist for additional guidance on this standard.
1
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
2
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
3

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
4
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed administration and management infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
County/Municipality Administered Agency, State Administered Agency (Central Office), or other Public Entity
  • BSM procedures including procedures for:
    1. obtaining consent
    2. notifying parents/guardians of incidents involving restrictive interventions 
    3. conducting assessments and developing behavior management plans
State Administered Agency (Regional Office)
  • No Self-Study Evidence
County/Municipality Administered Agency, State Administered Agency (Central Office), or other Public Entity
  • Copy of written behavior support and management philosophy and procedures provided to service recipients and/or parents/legal guardians
All Agencies
  • Interviews may include:
    1. Clinical director
    2. Relevant personnel
    3. Persons served
  • Review case records

 
Fundamental Practice

PA-BSM 2.01

The agency:
  1. provides an explanation for and offers a copy of its written restrictive behavior support and management philosophy and procedures to service recipients or their parents/legal guardians at admission;
  2. annually obtains the individual’s or parent’s/legal guardian’s consent when restrictive behavior management interventions are part of the treatment modality; 
  3. informs the individual or parent/legal guardian of the service implications, if any, of refusing to sign; and
  4. when the individual is a minor or has a legal guardina, notifies the parents/legal guardians promptly when the minor is involved in an incident involving a restrictive intervention.
Juvenile Justice

Interpretation

COA recognizes that it may be difficult for agencies providing residential juvenile justice services to involve youths' parents/legal guardians, especially when youth are placed outside of their communities and far from their families; however, agencies should still strive to involve families to the extent possible. When promptly notifying parents/legal guardians in the wake of an intervention proves difficult, the agency should document its efforts to initiate contact in the case record.

Additionally, when an agency provides involuntary services to youth involved with the juvenile justice system, obtaining consent may not be required.

 
Fundamental Practice

PA-BSM 2.02

The agency collaborates with the individual and/or parent/legal guardian to screen or assess for:
  1. the individual’s perception of emotional and physical safety;
  2. past experiences with restrictive behavior management interventions;
  3. antecedents or emotional triggers and the resulting behaviors; 
  4. previous successes in utilizing strategies and coping skills to mitigate the need for restrictive behavior management interventions;
  5. psychological and social factors that can influence use of such interventions, including trauma history; and 
  6. medical conditions or factors that could put the person at risk.
Interpretion: When the screening or assessment is conducted by an outside provider the agency should maintain a copy in the case record.
Examples: Medical factors can include issues related to use of medications, such as an insulin imbalance. Psychological and social factors may include psychosis or claustrophobia.

 
Fundamental Practice

PA-BSM 2.03

A behavior support and management plan is based on assessment results and:
  1. identifies proactive, strengths-based strategies that will help the person de-escalate their behavior and prevent harassing, violent, or out-of-control behavior; 
  2. specifies interventions that may or may not be used, taking the individual’s trauma history into account; 
  3. is modified as necessary; and 
  4. is developed in collaboration with the individual and signed by the person, their parent/legal guardian, and personnel, as appropriate. 
Note: The behavior support plan, sometimes called a crisis plan, can be part of, and reviewed with, the overall service or treatment plan.